多学科协作诊治模式下运行结直肠癌综合治疗的临床对照研究

Case-Control Study of Colorectal Cancer Combined-Therapy in Multi-Disciplinary Team

目的探讨四川大学华西医院结直肠外科多学科协作(MDT)诊治模式的运行效果。方法回顾性分析从2006年12月至2007年5月,在四川大学华西医院结直肠外科住院治疗的大肠癌患者的病历资料,比较MDT组与非MDT组的疗效。结果MDT组围手术期住院时间及外科住院时间少于非MDT组(P<0.05),但住院总时间上2组间差异无统计学意义(P>0.05)。在手术治疗结果上,MDT组肿瘤手术切除率高于非MDT组(P<0.05)。从术后早期并发症的发生情况分析,MDT组术后早期肠梗阻发生率低于非MDT组(P<0.05),但吻合口漏和吻合口出血发生率2组间差异无统计学意义(P>0.05)。经过5～10个月的随访,MDT组的患者术后肿瘤复发率低于非MDT组(P<0.05),而术后吻合口狭窄和肠梗阻的发生率,2组间差异无统计学意义(P>0.05)。结论结直肠肿瘤MDT模式针对大肠癌采用综合治疗方案,不仅有利于治疗方案的合理时间分配,而且提高了治疗效果。但对于MDT模式的影响因素尚缺乏系统性研究,同时还需将MDT模式中手术治疗的多模式环节进一步完善,以推出更为细化的围手术期MDT模式。

Objective To discuss the performance of multi-disciplinary team （MDT） of colorectal cancer treatment within We.st China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group （P〈：0.05）, but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection （P〈：0.05）. Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn＇t show any variations between the two groups, the non-MDT model group encountered more early postoperative ileus （P〈0.05）. During the 5--10 months follow-up, there came out less cancer recurrence rate in the MDT model group than the other （P〈0. 05）. And the morbidity of anastomotic stricture and ileus didn＇t show any statistical difference between the two groups. Conclusion The combined-therapy strategy of colorectal cancer has showed a priority to routine ways, not only the more reasonable time arrangement for therapy, but also the more satisfied surgical outcomes. However, the factors correlated to the efficacy of the MDT model are not clear; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come true.